An estimated 300 to 400 U.S. doctors kill themselves each year””a suicide rate thought to be higher than in the general population, although exact figures are unknown.
Some doctors are wary of admitting psychiatric problems because they feel it could harm their careers, so they suffer in silence to avoid the magnified stigma of mental illness in a profession where stoicism and bravado are valued.
When their pain becomes unbearable, doctors have the access and specific knowledge of prescription drugs to stop breathing and halt the heart.
“All physicians have access to neat, clean ways to commit suicide,” said Dr. Robert Lehmberg, a Little Rock, Ark., surgeon who has battled depression. He has admittedly considered suicide “an exit strategy if absolutely necessary.”
Physician suicide has been called “an endemic catastrophe” by the American Medical Association. Two years ago they pledged to begin work on prevention of the problem.
Still, suicides have persisted and the American Foundation for Suicide Prevention has begun an educational campaign to make troubled doctors more willing to seek help.
The program is funded by the American College of Psychiatrists and Wyeth Pharmaceuticals, a maker of anti-depressants. A documentary made by the program titled “Struggling in Silence” is set to air on public television stations.
Dr. Paula Clayton, the suicide foundation’s medical director, said it’s an issue that has really been swept under the carpet.
Research from the foundation suggests 300 to 400 physician suicides a year, but a precise count would require further study.
A recent article published in American Medical News by Dr. Louise Andrew puts the estimate at 250 a year, but accurate numbers aren’t available because the AMA doesn’t track doctor suicides, according to a spokesman.
Suicide figures in society as a whole are typically unreliable, as suicide is often not given as the cause of death.
Recent government data in the U.S. shows the overall suicide rate among men is four times higher than in women (23 per 100,000 versus about 6 per 100,000 in women).
However, among doctors suicide rates are equal among men and women.
Women doctors were more than twice as likely as women in the general population to kill themselves, according to a 28-state study from 1984-95. Men were more than 70 percent more likely inside the medical profession than overall to commit suicide.
“One explanation is that most suicide attempts in the broader population are unsuccessful, while doctors know how to successfully commit suicide,” said Dr. Erika Frank, who specializes in research on physician health.
Depression is usually the catalyst.
Dr. Glenn Siegel, who runs a suburban Chicago program that treats doctors with drug abuse, depression and other psychiatric problems, said that depressed doctors frequently decide to self-medicate but don’t seek psychotherapy that could help them deal with underlying issues.
“It’s not a safe topic to be as open about in that profession because you’re responsible for the well-being of others,” Siegel said. “If you’re admitting something like that, you’re saying maybe you’re not fit to do your job.”
“You just would rather take a risk with your health than your career. It’s not like you get a second chance with it,” said Lehmberg, who is featured in the documentary.
Some studies have suggested depression is more common among doctors, especially women physicians, and that the high demands of a job dealing with life-and-death issues makes them prone.
A study published last year in Denmark found more suicides in doctors than among more than 20 other professions, including nurses, factory workers, elementary school teachers, corporate managers and architects.
In the U.S., there are few comprehensive studies on suicides among U.S. doctors.
“Some have been based on newspaper obituaries, which are flawed at best because suicide often isn’t listed as a cause of death,” said Dr. Morton Silverman, a University of Chicago suicide expert.
Mumtaz Bari-Brown, widow of Ron Brown, a physician in New Jersey who took his own life in 2002 after a long battle with depression, said she believes the stigma kept her husband from getting help in time to save his life.
“We have to stop the hiding and the ignorance and recognize it as a disease like high blood pressure or diabetes,” said Bari-Brown, who also is featured in the new documentary.
“Doctors need assurance they won’t risk their jobs if they seek psychiatric help,” said Dr. G. Richard Smith, Lehmberg’s doctor and director of the University of Arkansas for Medical Sciences’ psychiatric research institute.
He has been successful in getting changes to questions on medical license applications in Arkansas that he believes will help. The older applications asked doctors if they were being treated for mental illness or ever had been. A “yes” answer required a psychiatrist’s note declaring they were fit to practice medicine. Now, they need only disclose mental health treatment that was advised or required by medical authorities.
“The previous form didn’t keep doctors with psychiatric problems from practicing. But it did keep doctors who needed treatment from getting the treatment that they needed,” Smith said.
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